1445 Portland Ave Suite 201
Rochester, NY 14621
Treatment of PIP joint Pilon fractures with Open reduction and Internal fixation
June 1st, 2007
When the base of the middle phalanx--P-2--is fractured via a compression type injury, a "pilon" fracture results. The joint surface typically becomes comminuted, but in most cases the ligaments are in tact, and the joint is stable. If the fragments are of sufficient size to allow fixation with small pins or screws, this technique becomes as option--obviating the use of complex splints as would be used with indirect techniques such as Shenk traction (see article on this page). I will discuss the feasibility and role of this particular option with you during your appointment.Related Photos:
Case 1. Preoperative lateral xray shows both joint depression and "burst" in the AP dimension
Preoperative PA xray
Intraoperative photo shows degree of articular disruption
Photo after reduction and screw fixation. The PIP joint has a remarkable capacity to remodel so long as stability and congruity are restored
Final PA xray
Final lateral xray
Finger flexion at 4 months
Finger extension
Case 2. Preoperative PA xray
Preoperative lateral xray shows characteristic "splay/burst" of a pilon fracture
Note severe articular disruption/comminution
Volar beak of P-2 is reconstituted and stabilized with k wires (note intraop video below)
Postoperative PA xray
Postoperative lateral xray
Related Videos:
Intraoperative exam after ORIF shows the stability afforded by the intervention